3821 SHORE AVE 2024-02-28 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS:Email application&submittal documents to PermitServices@everettwa.gov or drop off at 3200 Cedar Street 2nd Floor Drop Box WASHINGTON CONTACT INFORMATION:(P)425-257-8810 1(E)PermitSeryices@everettwa.gov I(W)everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:3821 Shore Ave Everett, WA, 98203 SITE WORK FOR PROJECT TYPE: @SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB#: DESCRIPTION OF SITE WORK/ RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWA TER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ Combined Sewer ❑ ASPHALT/CONCRETE PAVING SF ❑ Separated Storrs Sewer ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound @ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT 4 FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: @ CLEARING/GRADING/FILL/EXCAVATE �,� �' CY ❑ MR2 Only ❑ MR1-5 ❑MR1-9 ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): ITotal New+Replaced: SF This retaining wall is not over 4 ft but a permit was requested to fulfill the city of Everett Shoreline Master Program. Please use as a reference the Notice to Comply Case Number CE22-1217 attachec. I have also attached to this application The Geolechnical report and Geologicalngineering Design recommendations to fulfill The requremen s. CONTACT INFORMATION OWNER/APPLICANT NAME:Vullnet Hazizaj OWNER/APP. MAILING ADDRESS: STREET 4909 Glenwood Ave CITY Everett STATE WA z,P 98203 OWNER/APP. PHONE:(253)347-1970 OWNER/APP. EMAIL:Vullnet.Hazizaj@gmail.com `Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: @ OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:(253)347-1970 Vu l l n et H az i z a j CONTACT EMAIL:Vullnet.Hazizaj@gmail.com ACKNOWLEDGEMENT I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal,state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance. l am the owner,or I am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 3/24/2023 PERMIT# Owner! horize ent Si a e Date (Revised 4/21/2022)